Skip to main content
SpringerLink
Log in

Comorbidity of conduct disorder symptoms and internalising problems in children: investigating a community and a clinical sample

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Previous studies have demonstrated that many children with conduct problems (CP) also show internalising psychopathology (IP). However, it remains unclear whether the presence of IP serves as a protective or risk factor for the severity and development of CP. The aim of the present study was to assess the prevalence and associations of comorbid IP in children with CP in a community and a clinical sample. Data from boys as well as girls with CP in the clinical range were obtained from a community sample (n = 1,160) and a clinical sample diagnosed with disruptive behaviour disorder (n = 193) from two European countries. In the community sample, information was obtained using the strengths and difficulties questionnaire, whereas in the clinical sample, the child behaviour checklist was used. Internalising disorders, according to ICD-10, were also assessed in the clinical sample. For both samples, age, gender, and impact of comorbid IP in the clinical range (above 90th percentile) for CP were explored. Results revealed that in both samples, participants with CP showed a high rate of comorbid IP (community sample: 35%; clinical sample: 78%). Participants with comorbid IP were more likely to experience social problems with peers. In the clinical sample, comorbid IP rated by the parents was more prevalent than internalising disorders according to ICD-10. Boys with CP and comorbid IP demonstrated a higher severity of externalising behaviour than boys without comorbid IP in the clinical sample. We concluded that in both samples, we found a high co-occurrence of CP and IP. Based on the idea that the co-occurrence of IP and CP in children and adolescents may potentially lead to increased antisocial behaviour, internalising psychopathology should be carefully investigated. Effective strategies and specific risk factors must be evaluated to treat comorbidity as early as possible in children with CP and IP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Achenbach TM (1991) Childbehavior checklist—Deutsche version. Hogreve, Göttingen

    Google Scholar 

  2. Angold A, Costello EJ (1993) Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues. Am J Psychiatry 150:1779–1791

    PubMed  CAS  Google Scholar 

  3. Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87

    Article  PubMed  CAS  Google Scholar 

  4. Capaldi DM (1992) Co-occurence of conduct problems and depressive symptoms in early adolescent boys: II. A 2-year follow-up at grade 8. Dev Psychopathol 4:125–144

    Google Scholar 

  5. Coid J, Ullrich S (2010) Antisocial personality disorder and anxiety disorder: a diagnostic variant? J Anxiety Disord 24:452–460

    Article  PubMed  Google Scholar 

  6. Costello EJ, Janiszewski S (1990) Who gets treated? Factors associated with referral in children with psychiatric disorders. Acta Psychiatr Scand 81:523–529

    Article  PubMed  CAS  Google Scholar 

  7. Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844

    Article  PubMed  Google Scholar 

  8. Drabick DA, Gadow KD, Sprafkin J (2006) Co-occurrence of conduct disorder and depression in a clinic-based sample of boys with ADHD. J Child Psychol Psychiatry 47:766–774

    Article  PubMed  Google Scholar 

  9. Gifford-Smith M, Dodge KA, Dishion TJ, McCord J (2005) Peer influence in children and adolescents: crossing the bridge from developmental to intervention science. J Abnorm Child Psychol 33:255–265

    Article  PubMed  Google Scholar 

  10. Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345

    Article  PubMed  CAS  Google Scholar 

  11. Goodman R, Scott S (1999) Comparing the strengths and difficulties questionnaire and the child behavior checklist: is small beautiful? J Abnorm Child Psychol 27:17–24

    Article  PubMed  CAS  Google Scholar 

  12. Greene RW, Biederman J, Zerwas S, Monuteaux MC, Goring JC, Faraone SV (2002) Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. Am J Psychiatry 159:1214–1224

    Article  PubMed  Google Scholar 

  13. Gregory AM, Caspi A, Moffitt TE, Koenen K, Eley TC, Poulton R (2007) Juvenile mental health histories of adults with anxiety disorders. Am J Psychiatry 164:301–308

    Article  PubMed  Google Scholar 

  14. Herpertz SC, Mueller B, Wenning B, Qunaibi M, Lichterfeld C, Herpertz-Dahlmann B (2003) Autonomic responses in boys with externalizing disorders. J Neural Transm 110:1181–1195

    Article  PubMed  CAS  Google Scholar 

  15. Hodgins S, De Brito SA, Chhabra P, Cote G (2010) Anxiety disorders among offenders with antisocial personality disorders: a distinct subtype? Can J Psychiatry Rev 55:784–791

    Google Scholar 

  16. Ingoldsby EM, Kohl GO, McMahon RJ, Lengua L (2006) Conduct problems, depressive symptomatology and their co-occurring presentation in childhood as predictors of adjustment in early adolescence. J Abnorm Child Psychol 34:603–621

    PubMed  Google Scholar 

  17. Kazdin AE, Whitley MK (2006) Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior. J Consult Clin Psychol 74:455–467

    Article  PubMed  Google Scholar 

  18. Keiley MK, Lofthouse N, Bates JE, Dodge KA, Pettit GS (2003) Differential risks of covarying and pure components in mother and teacher reports of externalizing and internalizing behavior across ages 5 to 14. J Abnorm Child Psychol 31:267–283

    Article  PubMed  Google Scholar 

  19. Kerr M, Tremblay RE, Pagani L, Vitaro F (1997) Boys’ behavioral inhibition and the risk of later delinquency. Arch Gen Psychiatry 54:809–816

    Article  PubMed  CAS  Google Scholar 

  20. Klasen H, Woerner W, Wolke D, Meyer R, Overmeyer S, Kaschnitz W, Rothenberger A, Goodman R (2000) Comparing the German versions of the strengths and difficulties questionnaire (SDQ-Deu) and the child behavior checklist. Eur Child Adolesc Psychiatry 9:271–276

    Article  PubMed  CAS  Google Scholar 

  21. Lehto-Salo P, Narhi V, Ahonen T, Marttunen M (2009) Psychiatric comorbidity more common among adolescent females with CD/ODD than among males. Nord J Psychiatry 63:308–315

    Article  PubMed  Google Scholar 

  22. Levy K, Hunt C, Heriot S (2007) Treating comorbid anxiety and aggression in children. J Am Acad Child Adolesc Psychiatry 46:1111–1118

    Article  PubMed  Google Scholar 

  23. Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA (1993) Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol 102:133–144

    Article  PubMed  CAS  Google Scholar 

  24. Loeber R, Keenan K (1994) Interaction between conduct disorder and its comorbid conditions: effects of age and gender. Clinical Psychol Rev 14:497–523

    Article  Google Scholar 

  25. Loney BR, Lima EN, Butler MA (2006) Trait affectivity and non-referred adolescent conduct problems. J Clin Child Adolesc Psychol 35:329–336

    Article  PubMed  Google Scholar 

  26. March JS, Swanson JM, Arnold LE, Hoza B, Conners CK, Hinshaw SP, Hechtman L, Kraemer HC, Greenhill LL, Abikoff HB, Elliott LG, Jensen PS, Newcorn JH, Vitiello B, Severe J, Wells KC, Pelham WE (2000) Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD (MTA). J Abnorm Child Psychol 28:527–541

    Article  PubMed  CAS  Google Scholar 

  27. Maughan B, Rowe R, Messer J, Goodman R, Meltzer H (2004) Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology. J Child Psychol Psychiatry 45:609–621

    Article  PubMed  Google Scholar 

  28. Mcgee R, Feehan M, Williams S, Partridge F, Silva PA, Kelly J (1990) Dsm-III disorders in a large sample of adolescents. J Am Acad Child Adolesc Psychiatry 29:611–619

    Article  PubMed  CAS  Google Scholar 

  29. Moffitt TE, Caspi A, Harrington H, Milne BJ (2002) Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Dev Psychopathol 14:179–207

    Article  PubMed  Google Scholar 

  30. Newcorn JH, Miller SR, Ivanova I, Schulz KP, Kalmar J, Marks DJ, Halperin JM (2004) Adolescent outcome of ADHD: impact of childhood conduct and anxiety disorders. CNS Spectr 9:668–678

    PubMed  Google Scholar 

  31. Ollendick TH, Jarrett MA, Grills-Taquechel AE, Hovey LD, Wolff JC (2008) Comorbidity as a predictor and moderator of treatment outcome in youth with anxiety, affective, attention deficit/hyperactivity disorder, and oppositional/conduct disorders. Clin Psychol Rev 28:1447–1471

    Article  PubMed  Google Scholar 

  32. Olsson M (2009) DSM diagnosis of conduct disorder (CD)—a review. Nord J Psychiatry 63:102–112

    Article  PubMed  Google Scholar 

  33. Pfeffer CR, Plutchik R (1989) Co-occurrence of psychiatric disorders in child psychiatric patients and nonpatients: a circumplex model. Compr Psychiatry 30:275–282

    Article  PubMed  CAS  Google Scholar 

  34. Rey JM (1994) Comorbidity between disruptive disorders and depression in referred adolescents. Aust N Z J Psychiatry 28:106–113

    Article  PubMed  CAS  Google Scholar 

  35. Robins LN, Price RK (1991) Adult disorders predicted by childhood conduct problems: results from the NIMH epidemiologic catchment area project. Psychiatry 54:116–132

    PubMed  CAS  Google Scholar 

  36. Rowe R, Maughan B, Costello EJ, Angold A (2005) Defining oppositional defiant disorder. J Child Psychol Psychiatry 46:1309–1316

    Article  PubMed  Google Scholar 

  37. Scott S, Knapp M, Henderson J, Maughan B (2001) Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ 323:191

    Article  PubMed  CAS  Google Scholar 

  38. Sourander A, Jensen P, Davies M, Niemelä S, Elonheimo H, Ristkari T, Helenius H, Sillanmäki L, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F (2007) Who is at greatest risk of adverse long-term outcomes? The Finnish from boy to a man study. J Am Acad Child Adolesc Psychiatry 46:1148–1161

    Article  PubMed  Google Scholar 

  39. van Lier PA, Verhulst FC, van der Ende J, Crijnen AA (2003) Classes of disruptive behaviour in a sample of young elementary school children. J Child Psychol Psychiatry 44:377–387

    Article  PubMed  Google Scholar 

  40. Walker JL, Lahey BB, Russo MF, Frick PJ, Christ MA, McBurnett K, Loeber R, Stouthamer-Loeber M, Green SM (1991) Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment. J Am Acad Child Adolesc Psychiatry 30:187–191

    Article  PubMed  CAS  Google Scholar 

  41. Waschbusch DA (2002) A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems. Psychol Bull 128:118–150

    Article  PubMed  Google Scholar 

  42. Washburn JJ, Romero EG, Welty LJ, Abram KM, Teplin LA, McClelland GM, Paskar LD (2007) Development of antisocial personality disorder in detained youths: the predictive value of mental disorders. J Consult Clin Psychol 75:221–231

    Article  PubMed  Google Scholar 

  43. Wiesner M, Kim HK (2006) Co-occurring delinquency and depressive symptoms of adolescent boys and girls: a dual trajectory modeling approach. Dev Psychol 42:1220–1235

    Article  PubMed  Google Scholar 

  44. Wolff JC, Ollendick TH (2006) The comorbidity of conduct problems and depression in childhood and adolescence. Clin Child Family Psychol Rev 9:201–220

    Article  Google Scholar 

  45. Woolfenden S, Williams K, Peat J (2001) Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10–17. Cochr Database Syst Rev

  46. Zahn-Waxler C, Shirtcliff EA, Marceau K (2008) Disorders of childhood and adolescence: gender and psychopathology. Annu Rev Clin Psychol 4:275–303

    Article  PubMed  Google Scholar 

  47. Zoccolillo M (1992) Co-occurrence of conduct disorder and its adult outcomes with depressive and anxiety disorders: a review. J Am Acad Child Adolesc Psychiatry 31:547–556

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany

    Georg G. Polier, Timo D. Vloet & Beate Herpertz-Dahlmann

  2. Child Neuropsychology Section, Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany

    Georg G. Polier & Timo D. Vloet

  3. JARA Translational Brain Medicine, Aachen, Germany

    Beate Herpertz-Dahlmann

  4. Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry , King’s College London, London, UK

    Kristin R. Laurens & Sheilagh Hodgins

  5. Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia

    Kristin R. Laurens

  6. Schizophrenia Research Institute, Sydney, Australia

    Kristin R. Laurens

  7. Department of Psychiatry, Heidelberg University, Heidelberg, Germany

    Sheilagh Hodgins

  8. Département de Psychiatrie, Université de Montréal, Montreal, Canada

    Sheilagh Hodgins

Authors
  1. Georg G. Polier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timo D. Vloet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beate Herpertz-Dahlmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristin R. Laurens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sheilagh Hodgins
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georg G. Polier.

Additional information

Georg G. Polier and Timo D. Vloet equally contributed to the paper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Polier, G.G., Vloet, T.D., Herpertz-Dahlmann, B. et al. Comorbidity of conduct disorder symptoms and internalising problems in children: investigating a community and a clinical sample. Eur Child Adolesc Psychiatry 21, 31–38 (2012). https://doi.org/10.1007/s00787-011-0229-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-011-0229-6

Keywords

Search

Navigation